critical“The service did not always ensure there were sufficient numbers of suitable staff to support people to stay safe and meet their needs.”
missed or late visits
1 finding
critical“on 3 July 2022, a staff member arrived at 2pm instead of 1pm. This was repeated several times during the course of July 2022.”
person centred care
1 finding
moderate“I should have two care workers but sometimes only one care worker comes.”
incident learning
1 finding
moderate
“missed and late calls were recorded, these were not treated as incidents...not subjected to a comprehensive analysis to make sure data was acted upon in a timely manner”
governance
1 finding
moderate“There were no robust procedures to follow in an emergency to make sure sufficient and suitable staff were deployed to cover both the emergency and the routine work.”